An Analytical Examination of the Association Between Poverty and Underutilisation of Maternal Health Services in North West Nigeria

Poverty is consistently theorised as a fundamental determinant of maternal health service underutilisation, but the specific pathways through which household economic status influences antenatal care, skilled delivery, and postnatal care use in North West Nigeria have not been empirically characterised. This study analytically examined the relationship between poverty and utilisation of maternal health services using nationally representative 2023 NDHS data for the North West geopolitical zone. A secondary data analytical study was conducted using NDHS data for 1,820 women in the North West zone who had delivered in the five years preceding the survey. Wealth index quintiles were used as the primary poverty indicator. Outcome variables were antenatal care adequacy (four or more visits), skilled birth attendance, and postnatal care within 48 hours. Mediation analysis using logistic regression with Baron-Kenny methodology examined whether educational attainment, distance to facility, and decision-making autonomy mediated the poverty-utilisation relationship. Results showed a gradient of increasing service utilisation from the lowest to the highest wealth quintile for all three services. Adjusted analysis confirmed significant wealth effects on ANC adequacy (OR 3.4 for richest versus poorest; p < 0.001) and skilled delivery (OR 5.8; p < 0.001). Educational attainment explained 34 percent of the wealth effect on skilled delivery. Decision-making autonomy mediated 18 percent of the poverty effect on ANC. The study recommends poverty-responsive maternal health financing, female education investment, and women's empowerment as complementary approaches to reducing maternal health service inequality in North West Nigeria.